The Extra Help program, also called the LIS (Low Income Subsidy), is available to individuals who come below specific personal and income resource limits. This is essentially a federal program that assists in paying for expenses linked with prescription drugs’ Medicare coverage. This help might reduce your amounts for prescription drug copayments, as well as eliminate or decrease your Medicare Prescription Drug Plan deductibles and premiums.

Benefits of the Extra Help Program and Working with Medicare Part D

This program provides these benefits to individuals:

  • Pays the cost for your Medicare Part D premium up to a certain benchmark amount that is specific to the state
  • Provides you a SEP (Special Enrollment Period) once every quarter of the calendar during the year’s first nine months. It allows you to enroll and sign up in a Part D Medicare plan or switch Medicare plans (one is not allowed to use the Extra Help Special Enrollment Period during the year’s 4th calendar quarter (from October to December). 

To make changes to prescription drug coverage in this period, you ought to utilize Fall Open Enrollment.

  • Gets rid of any late enrollment penalty for Part D that you might have incurred if you postponed enrollment for Medicare Part D for whatever reason.
  • Reduces your Prescription Drug Expenses

Contingent on your assets and income, you might be eligible for either partial or full Extra Help. Both of the programs offer help with the expenses of your drugs. To get such help, your prescription has to be on the formulary of your plan, and you must utilize pharmacies in the particular network of your plan.

It is important to keep in mind that the Extra Help program is not a substitute for Part D or an entire plan by itself: You still have to have a Medicare Part D plan to get assistance for Extra Help and coverage for Medicare prescription drugs. You will be automatically enrolled in a plan (in most cases) if you do not select a plan.

Taking Extra Help and Plan D Decision

You may qualify for Extra Help and have other reputed drug coverage already. And you may need to assess your coverage and costs when deciding whether to enroll in Extra Help and Part D or maintain your existing drug coverage. 

Make sure you ask your previous union or employer if you can receive a Medicare Part D plan without losing the retiree privileges you would like to hold on to. You can check if opting out from retiree coverage still qualifies you for any other retiree health privileges.

If you would like to learn about your eligibility for the Extra Help Program and Part D or have any other queries, make sure to get in touch with us.